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Beth Conroy Compendium - STROKE (Cerebrovascular Attack) APM Style

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SOURCES: 1.AManualofAcupuncture,pages95121,125174Deadman,AlKhafaji,Baker 2.ThePracticeofChineseMedicine,TheTreatmentofDiseasewithAcupunctureandChinese HerbsVol2pgs11911218Maciocia,Giovanni 3.AcupunctureAComprehensivetext,pages49750Bensky,Dan 4.AcupuncturePhysicalMedicine,pages8595,97120,121130,Seem,Mark 5.HandoutfromCarolynBengston'sScalpAcupunctureClass(PhotocopiesofAcupuncturea ComprehensiveText) DESCRIPTIONOFCONDITION:

InAPMandChinesemedicine,WindStroke(ZhongFeng)isthesameasfourmajorconditions inwesternmedicaldiagnosis: cerebralhemorrhage cerebralthrombosis cerebralembolism spasmofacerebralvessel

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Beth Conroy Compendium - STROKE (Cerebrovascular Attack) APM Style

spasmofacerebralvessel Zhong=SuddenOnset Feng=Wing

Cerebralhemorrhageisbleedingintothesubarachnoidspaceformtheintracerebralartery. Cerebralthrombosisispartialortotalobstructionofacerebralarteryfromathrombosisresulting ininfarctionandanoxiaofthesurroundingtissue.Athrombosisisablotclotthatformsinthe arteryliningandremainsattachedtowhereitoriginated. Cerebralembolismisanembolusthatdetachesfromthethrombusandclosesthecerebralartery causinginfarctionandanoxiaofthecerebraltissue.Embolusisabubbleofairorapieceofa thrombosisthatgetsdetachedandtravelsalongthearterialsystemcausingtheclosingofan artery. Spasmofcerebralvesseliscausedbytheclosingofthevesseltemporarilyinwhichitcontracts. Apassingembolusmaybethecauseinwhichittemporarilynarrowsthevessel'slumencausing anoxiaorinfarctionofthesurroundingtissue.Becausethisistheleastseriousofthefourit usuallyresultsincompleterecovery. AetiologyandPathology: Windstrokeisacomplexconditionbecausealthoughitoccursquicklyithasbeenbrewingup overyears.Ithasfourmainfactors: 1.Overwork,EmotionalStressandExcessiveSexualActivity:KidneyYinDeficiencyiscaused byworkinglonghoursinstressfulconditions,lackofrest,emotionalstrain,andexcessivesexual activity.ThesecombinationsarethemostcommoncauseofKidneyYindeficiencyin industrializedsocieties.KidneyYinDeficiencyleadstoLiverYinDeficiencyandthenLiver YangRising.TheRisingofLiverYangofteninelderlyleadstoLiverWind,whichcauses apoplexy,coma,mentalcloudiness,paralysis,andthetongueismoving,deviatedorstiff.There mayalsobeinteractionsbetweenInternalandExternalwind,asExternalwindmaycausethe stirringofInternalWind. 2.IrregularDietandPhysicalOverwork:Irregulareatingortheeatingofexcessiveamountsof fats,dairy,greasy,friedfoodsandsugarwillweakentheSpleencausingPhlegmandcanalso leadtoobesity.OvertimethiscausesPhlegmFire.Numbnessofthelimbs,mentalcloudiness, slurredspeech,oraphasia,andaswollentonguewithastickycoatingarecausedbyPhlegm.

3.ExcessiveSexualActivityandInadequateRest:KidneyEssenceisweakenedbythesefactorsand

leadstomarrowdeficiency.WhenmarrowisdeficientitfailstonourishtheBloodandwilllead toStasis.Bloodstasiscausesweaknessofthelimbsandthetonguetobepurple. 4.PhysicalOverworkandInadequateRest:Physicaloverwork,includingexcessivelifting, exerciseorsportsweakenstheSpleen,themusclesandthechannels.PreexistingInternalWind exploitsQiandBloodDeficiencyinthechannelsandpenetratesthem.Paralysisofthelimbsis causedbyExternalWindsettingoffInternalWind. WINDPHLEGMFIRESTASIS (TPOCM,pages11911218Maciocia)

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Beth Conroy Compendium - STROKE (Cerebrovascular Attack) APM Style

PATTERNSOFDISHARMONY(FACESOFFATIGUEZONEORTMDYSFUNCTION): Zone:YangMingSTandLIMeridian FullAspect: Internalwind Phlegm Fire Bloodstasis EmptyAspect: QiandBloodDeficiency YinDeficiency

(TPOCM,pages11911218Maciocia)
CLINICALMANIFESTATIONS: AttackoftheInternalorgans: SevereType: TwoTypesofSevere 1.Tense/ClosedTypeisaCollapseofYinwithsuddencollapse,lossofconsciousness,coma, clenchedteeth,closedfists,lockjaw,redfaceandearsprofusesputum,rattlingsoundsinthe throat,coarsebreathing,constipationandretentionofurine.Pulse:Wiry,Full,Rapid,Slippery. Tongue:RedBody,Stiff,Deviated,StickyYellowCoating. 2.Open/FlaccidTypeisaCollapseofYangwithsuddencollapse,lossofconsciousness, coma,handsandmouthopen,eyesclosed.Pulse:Minute,hidden,Scattered.Tongue:Pale, Swollen. Mildtype: 1.AttackoftheMainChannels:Facialparalysis,hemiplegia,numbnessoflimbs,limitationof movement,slurredspeech(notalwayspresent). 2.AttackofLuoConnectingChannelsOnly:unilateralnumbnessoffaceandlimbs,slurred speech(notalwayspresent).

(TPOCM,pages11911218Maciocia)

PALPATORYFINDINGS:
PalpationoftheYangMingZone:STandLIMeridiansforKori's/SensitivePointsalongthe Channels,indicatingthepointsthatwillbeusedfortreatmentofparalysis,numbness,and tingling.Also,palpatetheheadforsensitivedentsorspotsalongtheMotorLineandthe SensoryLineindicatingthepointsalongtheseLinestobeusedintreatmentofparalysis, numbness,tinglingandaphasia StomachMeridian:SpecificPointstopalpatealongtheentireChannel:FromST31toSt40. LargeintestineMeridian:SpecificPointstoPalpatealongtheChannel:LI4toLI15. (AMOA,Deadman)
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Beth Conroy Compendium - STROKE (Cerebrovascular Attack) APM Style

TREATMENTPRINCIPLES: FromtheAPMperspectiveStrokedoesnotfallintotheFourPatternsofFatigue,Organsinan Uproar,MusculoskeletalStraightjackets,orChronicFatigue,sotheYangMingCircuitand scalppointsarebestutilizedtotreatthesymptomsofstroke.ThescalppointsarefromDan Bensky'sbook"AcupunctureAComprehensiveText."

TREATMENTSTRATEGIES:FromaTCM/APMApproach. AttackoftheInternalOrgans:TenseandFlaccidTypes AcuteStage: RelieveSpasm InduceResuscitation LowerBloodPressure TenseType: InduceResuscitation RelaxSpasm Clearheat ExtinguishWind ResolvePhlegm OpentheOrifices

FlaccidType: Recaptureyang InduceResuscitation AttackoftheChannelsAlone: RemoveObstructionFromtheChannels Extinguishwind ResolvePhlegm InvigoratetheLuoChannels MoveQiandBloodintheChannels

(TPOCM,pages11911218Maciocia)

TREATMENTPLAN: Thetreatmentplanwillcomefromscalpacupuncturetotreatthesensoryandmotorsymptoms andlimbpointsalongtheYangMingST/LImeridianstotreatlocalhemiplegia,numbness,and tingling. TheScalptreatmentsaredoneonthecontralateralsideoftheheadoftheaffectedStrokeside. TheheadisdividedintoareasofMotorArea,SensoryArea,andSpeecharea.Imaginarylines arevisualizedasinthephotosbelow:

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Whenlocatingthepointsonthescalpwithintheareasorlinesthatareneeded,locatethe pointsbyadentorsenstivespot,theremaybemorethanonedentorsensitivespot,needle themostsensitive.Needlesinthescalparestronglystimulatedandareneedledwitha#2628 gaugefiliformneedlesfrom2.53inchesinlength.Needlesareinsertedhorizontallytothescalp withouttouchingthebonewithslowrotationuntiltherequisiteportionoftheneedleisinserted. Onceinplaceneedlesarenotraisedorthrustedbutratherrapidlytwirled(200timesperminute isbest)inwideamplitude(23rotationsforwardand23rotationsbackward)untilDeQiis achieved.Continuethetwirlingfor34minutes,retainneedles510minutesandthentwirled again.Repeatprocedure23timesandthenremoveneedles.Acottonballmustbeusedwhen removingtheneedletopreventhematomas,bleedingandlumps.Mostcommonlythesensation feltisofheat,usuallyonthelimboppositesideofwhereneedled.Preciselocationofscalp pointsisimportantforeffectiveness.Stimulationofneedlesmustbestrongforresults.Itmay bebesttohavepatientliedownbeforetreatmenttofainting.(ACT,page498Bensky) PARALYSISOFUPPERLIMB: NeedleSecondandThirdFifthsoftheSensoryLineonoppositesideofeffectedlimb LI3difficultyflexingandextendingthefingers LI4painfulobstruction,hemiplegia,contractionofthefingers LI5contractionofthefivefingers LI8hemiplegia, LI9painandnumbnessofshoulder,arm,elbow,hemiplegiafromwindstroke,numbnessofthe limbs LI10windstroke,paralysisofthearm,numbnessofarm,contractionandinflexibilityofelbow LI11hemiplegia,atrophyoflowerlimbs LI12contraction,numbnessandimmobilityoftheupperarm LI13pain,numbness,orcontractionofelbowandupperarm LI14pain,numbness,wastingweaknessofupperlimb LI15hemiplegia,contractionandnumbnessofupperlimb,windparalysis,windstroke,wind atrphydisorder LI16difficultyinraisingthearm LI17 PARALYSISOFLOWERLIMB:
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Beth Conroy Compendium - STROKE (Cerebrovascular Attack) APM Style

NeedleUpperFifthMotorAreaLineonoppositesideofeffectedlimb NeedleLegMotorandSensoryAreaforparalysis,pain,ornumbnessoflowerlimb ST31paralysisofthelegiftenderorKoriisPresent ST32ifnumbnessandcontractionofthemuscles ST33atrophyoflegmuscles ST36lockjaw,lossofconsciousness ST37hemiplegia,legQi,numbnessandpainobstructionofthelowerlimb ST38atrophyoflowerlimb ST39hemiplegia,painfulobstructionoflowerlimb ST40hemiplegia,painfulobstructionoflowerlimb,witheringofthelowerlimb LOSSOFCONSCIOUSNESS: LI1lossofconsciousness LI19lockjaw,deviationofthemouth,lossofconsciousness APHASIA/SPEECH: NeedleUpperMotorNeuronforparalysisofface,motoraphasia,dribblingsaliva,impaired speech NeedleSpeech#2nominalaphasia NeedleSpeech#3receptiveaphasia LI17suddenlossofvoice,rattlingnoiseinthroat LI18suddenlossofvoice,rattlingnoiseinthroat FACIALPARALYSIS/LOCKJAW: NeedleChoreaandtremorcontrolareafortremorsinfaceandupper/lowerlimbs,facialpalsy NeedleUpperMotorNeuronforparalysisofface,motoraphasia,dribblingsaliva,impaired speech LI19lockjaw,deviationofthemouth,lossofconsciousness LI20deviationofthemouth Electroacupuncturemayalsobeusedinthistreatment.ElectroStimoftheheadmotorand sensorypointsaswellasmosttenderpointsoftheupperandlowerextremitiesisdone.This canbequiteintenseandmanypatientswilloptoutofElectrostim.Foranindepthtreatment usingelectroacupunctureseeKMStrokeTreatmentWiki.

ScalppointsfromBensky ST/LIPointsfromDeadman

PATIENTEDUCATION/RECOMMENDATIONS: Thepatientmustmakelifestylechangesconcerningdiet,stressandexercise.Togetherthese canreducethechancesofanotherstrokeontheoppositesideofthebrain.

PROGNOSIS: Forbestresultsthepatientshouldbeginacupuncturetreatmentswithinthefirstthreemonthsof stroke.Physicaltherapyisalsoessentialtotherecoveryofhemiplegia,numbnessandtingling.

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